Abdominal Compartment Syndrome: Improving Outcomes With A Multidisciplinary Approach – A Narrative Review

Figures & data

Table 1 Definitions

Condition	Definition
IAH IAH grade I IAP grade II IAP grade III IAP grade IV	Sustained or repeated IAP ≥12 mmHg IAP 12–15 mmHg IAP 16–20 mmHg IAP 21–25 mmHg IAP >25 mmHg
ACS Primary ACS Secondary ACS Recurrent ACS	Sustained IAP >20 mmHg that is associated with new organ dysfunction/failure Associated with injury or disease in the abdominopelvic region Associated with conditions that do not originate from the abdominopelvic region Condition in which ACS redevelops following previous surgical or medical treatment of primary or secondary ACS

Note: Data from Kirkpatrick et al.^29,13

Abbreviations: IAP, intra-abdominal pressure; IAH, intra-abdominal hypertension; ACS, abdominal compartment syndrome.

Figure 1 Estimated prevalence and mortality of different grades of IAH and of ACS. Note: Data from Iyer et al,¹³ Murphy et al,¹⁴ and Reintam Blaser et al.¹⁵

Abbreviations: IAH, intra-abdominal hypertension; ACS, abdominal compartment syndrome.

Figure 2 Nonsurgical management of IAH and ACS.

Note: Data from Kirkpatrick et al¹³ and Starkopf et al³⁴
Abbreviations: IAP, intra-abdominal pressure; IAH, intra-abdominal hypertension; ACS, abdominal compartment syndrome.

Table 2 Indications And Complications For Open Abdomen

Indications	Complications
Abdominal compartment syndrome	Fistula formation
Intra-abdominal hypertension	Infection
Severe intra-abdominal infection	Bleeding
Post-traumatic and non-trauma hemorrhage	Intra-abdominal abscess
Sepsis	Sepsis
Peritonitis	Hernia
Pancreatitis	Loss of domain
Bowel oedema or ischemia	Loss of bowel function
Hypothermia	Loss of fluids and protein
Acidosis
Re-exploration after trauma or abdominal sepsis

Note: Reproduced with permission from Fernández LG. Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon: management recommendations for open abdomen. Int Wound J. 2016;13(S3):25–34. Copyright  © 2016 John Wiley and Sons.⁶⁹

Figure 3 A clinical image of a patient with aortic injury subjected to damage control laparotomy with temporary abdominal closure using negative pressure wound therapy (NPWT).

Note: Photo courtesy of Peep Talving.

Figure 4 A clinical image of a patient with peritonitis and abdominal compartment syndrome subjected to fascial closure with negative pressure wound dressing and the ABRA system (Dynamic tissue systems, Barrie, Ontario, Canada). 

Note: Photo courtesy of Peep Talving.

Figure 5 Clinical images of a patient subjected to split-thickness skin graft as a temporary abdominal closure after achieving successful treatment of enteroatmospheric fistulas, and to definitive fascial closure after 3 months. 

Note: Photo courtesy of Peep Talving.

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